In a concise communication published in the August 2012 issue of Infection Control and Hospital Epidemiology, Erica S. Shenoy, MD, PhD, Rochelle P. Walensky, MD, MPH, Hang Lee, PhD, Benjamin Orcutt, CHAM, and David C. Hooper, MD, report on the impact of contact precautions (CP) for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE) on time to bed assignment.
The researchers surveyed patient access managers (PAMs) on the impact of CP for MRSA and VRE on time to bed assignment as well as investigated the factors influencing infection control policies allowing for discontinuation of CP. The majority of respondents reported an increase in time to bed assignment for patients with a history of MRSA and/or VRE infection or colonization.
The researchers note, "This survey is the first, to our knowledge, to document the impact of CP status on bed assignment from the perspective of PAMs. We found that the vast majority (>90 percent) of responding PAMs reported spending substantially more time assigning inpatient beds to patients who required CP accommodations for MRSA/VRE, with estimates of a doubling of the time required for other patients. This difference represents a 'hidden' cost of CP that, to our knowledge, has not been previously reported. The additional time may result in lengthier emergency department stays; studies have found significant and positive associations between delays to admission for emergency department patients and patient mortality. Moreover, patient satisfaction is adversely affected by increased waiting times."
The researchers add that "Reported policies for CP discontinuation for MRSA appear to correlate with cohorting policies. It may be that capacity constraints are driving institutions both to allow cohorting and to develop internal policies for discontinuation of CP. This linkage may relate to limitations in bed availability from cohorting. For example, in circumstances in which a patient on CP occupies a semiprivate room, the second bed may go unfilled because there is no sex-identical patient requiring similar CP."
Shenoy, et al. (2012) conclude that, "Policies that do not permit removal of CP are likely unsustainable, especially considering that MRSA colonization is transient in a substantial proportion of patients. Studies to define optimal policies for CP discontinuation are needed."
Reference: Shenoy, ES, et al. Resource Burden Associated with Contact Precautions for Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus: The Patient Access Managers Perspective. Infection Control and Hospital Epidemiology. Vol. 33, No. 8. August 2012.